Bomman S, Klair J S, Ashat M, El Abiad R, Gerke H, Keech J, Parekh K, Nau P, Hanada Y, Wong Kee Song L M, Kozarek R, Irani S, Low D, Ross A, Krishnamoorthi R
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Dis Esophagus. 2021 Dec 24;34(12). doi: 10.1093/dote/doab044.
Peroral endoscopic myotomy (POEM) in patients with achalasia who are status post bariatric surgery may be technically challenging due to postsurgical scarring and altered anatomy. The aim of the study was to assess the efficacy and safety of POEM for achalasia in patients with prior bariatric surgery. A review of prospectively maintained databases at three tertiary referral centers from January 2015 to January 2021 was performed. The primary outcome of interest was clinical success, defined as a post-treatment Eckardt score ≤ 3 or improvement in Eckardt score by ≥ 1 when the baseline score was <3, and improvement of symptoms. Secondary outcomes were adverse event rates and symptom recurrence. Sixteen patients status post Roux-en-Y gastric bypass (n = 14) and sleeve gastrectomy (n = 2) met inclusion criteria. Indications for POEM were achalasia type I (n = 2), type II (n = 9), and type III (n = 5). POEM was performed either by anterior or posterior approach. The pre-POEM mean integrated relaxation pressure was 26.2 ± 7.6 mm Hg. The mean total myotomy length was 10.2 ± 2.7 cm. The mean length of hospitalization was 1.4 ± 0.7 days. Pre- and postprocedure Eckardt scores were 6.1 ± 2.1 and 1.7 ± 1.8, respectively. The overall clinical success rate was 93.8% (15/16) with mean follow-up duration of 15.5 months. One patient had esophageal leak on postprocedure esophagram and managed endoscopically. Dysphagia recurred in two patients, which was successfully managed with pneumatic dilation with or without botulinum toxin injection. POEM appears to be safe and effective in the management of patients with achalasia who have undergone prior bariatric surgery.
对于接受过减肥手术的贲门失弛缓症患者，经口内镜下肌切开术（POEM）可能因术后瘢痕形成和解剖结构改变而在技术上具有挑战性。本研究的目的是评估POEM治疗既往接受过减肥手术的贲门失弛缓症患者的疗效和安全性。对三个三级转诊中心2015年1月至2021年1月前瞻性维护的数据库进行了回顾。感兴趣的主要结局是临床成功，定义为治疗后埃卡德特评分≤3，或当基线评分<3时埃卡德特评分提高≥1，以及症状改善。次要结局是不良事件发生率和症状复发。16例接受Roux-en-Y胃旁路手术（n = 14）和袖状胃切除术（n = 2）后的患者符合纳入标准。POEM的适应证为I型贲门失弛缓症（n = 2）、II型（n = 9）和III型（n = 5）。POEM通过前路或后路进行。POEM术前平均综合松弛压为26.2±7.6 mmHg。平均总肌切开长度为10.2±2.7 cm。平均住院时间为1.4±0.7天。术前和术后埃卡德特评分分别为6.1±2.1和1.7±1.8。总体临床成功率为93.8%（15/16），平均随访时间为15.5个月。1例患者术后食管造影显示食管漏，经内镜处理。2例患者吞咽困难复发，通过气囊扩张联合或不联合肉毒杆菌毒素注射成功处理。POEM在治疗既往接受过减肥手术的贲门失弛缓症患者中似乎是安全有效的。
